Annual Review Hospital Visits for Patients with Cystic Fibrosis

Abstract

Cystic fibrosis (CF) is a lifelong multisystem disease. All patients attend hospital on a regular basis for review and adjustment of treatment. They are treated in the clinic by a multidisciplinary team, all with a special interest and expertise in CF. The composition of the team varies somewhat, but usually comprises a doctor, a nurse, a physiotherapist and a dietition. Other departments variously involved include the ward nursing staff, radiology/imaging, social work, psychology, psychiatry, microbiology, gastroenterology/nutrition, surgery, pharmacy and the hospital contracts department. Little current treatment in CF is based on evidence from randomized controlled clinical trials, and many treatment regimens have been introduced into practice with no objective evaluation. Thus it is that without any controlled studies of benefit or cost, it has become the received wisdom and part of standard guidelines in the UK that all patients with CF should, in addition to regular 3-monthly hospital visits, attend for an in-depth review once a year1. The principle of this is to enable a much more detailed proactive appraisal than is possible during the routine outpatient clinic. In most centres, including ours, this annual review visit replaces a routine 3-monthly appointment. The immediate effect of annual review visits is to generate considerably increased activity by both patients (attending hospital, filling in diet or activity diaries) and staff, as well as consuming additional resources. The assumption is that all this additional activity is beneficial, but this has never been objectively demonstrated. Indeed, an obvious question, which has never been addressed, is why an annual review should be needed for patients who are already receiving a 3-monthly one. Annual reviews are so well established as part of routine practice that it would now be impossible to perform a randomized controlled trial. In order to try and evaluate annual reviews, we decided to test the hypothesis that annual review visits generate a larger number of interventions than are generated during routine outpatient clinic visits, using the number of medical, dietetic and physiotherapy interventions per attendance as the primary outcome variables.